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Member Rights and Responsibilities

Member Rights

As a valued member of NHP, you have the right to:

  • Receive information about NHP, our services, our providers and practitioners, your covered benefits, and your rights and responsibilities as a Member of NHP.
  • Receive documents in alternative formats and/or oral interpretation services free of charge for any materials in any language.
  • Have your questions and concerns answered completely and courteously.
  • Be treated with respect and with consideration for your dignity.
  • Have privacy during treatment and expect confidentiality of all records and communications.
  • Discuss and receive information regarding your treatment options, regardless of cost or benefit coverage, with your Provider in a way which is understood by you. You may be responsible for payment of services not included in the Covered Services list for your coverage type.
  • Be included in all decisions about your health care, including the right to refuse treatment and the right to receive a Second Opinion on a medical procedure at no cost to you.
  • Change your Primary Care Provider.
  • Access Emergency care twenty-four (24) hours a day, seven (7) days a week.
  • Access an easy process to voice your concerns, and expect follow-up by NHP.
  • File a Grievance or Appeal or if you have had an unsatisfactory experience with NHP or with any of our contracted Providers, or if you disagree with certain decisions made by NHP.
  • Make recommendations regarding NHP's Member rights and responsibilities.
  • Create and apply an Advance Directive, such as a will or a health care proxy, if you are over 18 years of age.
  • Be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
  • Freely apply your rights without negatively affecting the way NHP and/or your Provider treats you.
  • Ask for and receive a copy of your health record and request that it be changed or corrected, as explained in the Notice of Privacy Practices on page 59 of the Member Handbook.
  • Receive the Covered Services you are eligible for as outlined in the Covered Services list enclosed with the Member Handbook.

Member Responsibilities

As a Member of NHP, you also have responsibilities. It is your responsibility to:

  • Choose a Primary Care Provider, the Provider responsible for your care.
  • Call your Primary Care Provider when you need health care.
  • Tell any health care Provider that you are an NHP Member.
  • Give complete and accurate health information that NHP or your Provider needs in order to provide care.
  • Understand the role of your Primary Care Provider in providing your care and arranging other health care services that you may need.
  • To the degree possible, understand your health problems and take part in making decisions about your health care and in developing treatment goals with your Provider.
  • Follow the plans and instructions agreed to by you and your Provider.
  • Understand your benefits and know what is covered and what is not covered.
  • Call your Primary Care Provider within forty-eight (48) hours of any Emergency or Out-of-Network treatment. If you experienced a Behavioral Health Emergency you should contact your Behavioral Health Provider, if you have one.
  • Notify NHP of any changes in personal information such as address, telephone, marriage, additions to the family, eligibility of other health insurance coverage, etc.
  • Understand that you may be responsible for payment of services you receive that are not included in the Covered Services list for your coverage type.

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